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General NPI Number Information
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NPI Number | 1750699179
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Entity Type | Organization
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Legal Business Name | EVOLUTION PHARMACY SERVICE INC
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Dates
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Enumeration Date | 09/20/2010
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Last Update Date | 01/17/2017
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Provider Practice Location Address
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Address Line | 401 LAUREL ST
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City | PITTSTON
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State | PA
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Zip | 18640-3557
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Country | US
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Telephone | 570-534-0995
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Fax | 570-299-7896
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Provider Business Mailing Address
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Address Line | 401 LAUREL ST
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City | PITTSTON
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State | PA
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Zip | 18640-3557
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Country | US
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Telephone | 570-534-0995
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Fax | 570-299-7896
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEROME SAUTER
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Credential | RPH
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Telephone | 570-534-0995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PP482045
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License Number State | PA
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